Form 635_0010 - Limited Liability Company Application For Certificate Of Authority Page 2
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1
2Indicate if the limited liability company is a member-managed or manager-managed
8.
limited liability company by marking the appropriate box. State the name, street and mailing
address of one member/manager.
Member Managed
OR
Manager Managed
Name
Address
City
State
Zip
The effective date and time of this application, if different than the date and time
9.
of filing (Refer to note #5 on instruction page)
Date
Time
A certificate of existence or a record of similar import, signed by the secretary of state or
10.
other official having custody of the company's publicly filed report in the state or other
jurisdiction under whose law the company is formed, accompanies this application.
Signature
Date
Type or print name and title
_______
635_0010
7-1-2016
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